Provider Demographics
NPI:1366250888
Name:HENDERSON, AMBER (NCFBPPC-A)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:NCFBPPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 DUPREE ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5608 TEN TEN RD
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-8352
Practice Address - Country:US
Practice Address - Phone:919-779-1791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC126101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral